American Diabetes Association Guide to Herbs and Nutritional Supplements. Laura Shane-McWhorter

section, Part I, discusses what dietary supplements are, why you should exercise caution when taking supplements, and how to talk to your health care provider. It also describes how dietary supplements are regulated and how to shop wisely for these products.

      Part II summarizes 40 dietary supplements commonly used to treat diabetes and its complications. This is not a comprehensive directory of all the dietary supplements used to treat diabetes—just a snapshot of the most well-known products. The supplements are listed in alphabetical order so that you can easily look up a product in which you’re interested or considering taking. Each summary includes details on the supplement’s origin, general information about how the product is thought to work, potential side effects and drug interactions, and relevant scientific studies.

      Part III summarizes the information from Part II into a quick-reference table, making it easier to locate and read a brief summary of a particular supplement. While this table makes it convenient to identify a supplement quickly, it is recommended that you also read the full entry for any supplement in which you are interested.

      TYPES OF DIETARY SUPPLEMENTS

      Dietary supplements include everything from vitamins and minerals to herbs such as cinnamon and St. John’s wort. Hundreds of plant species have been used to treat diabetes throughout the ages. Indeed, the widely prescribed drug metformin belongs to a class of drugs that is related to the plant French lilac, or goat’s rue. Dietary supplements also come in a number of forms including tablets, capsules, powders, softgels, gelcaps, and liquids. And they are sold from a number of retailers including pharmacies, grocery stores, vitamin and health food stores, websites, and mail-order catalogs.

      The main types of dietary supplements this book will cover include:

      • Botanicals (derived from plants and possibly including herbs)

      • Vitamins

      • Minerals

      • Fatty Acids

      • Other Dietary Supplements

      REASONS FOR CAUTION: SIDE EFFECTS AND DRUG INTERACTIONS

      Dietary supplements may seem safe or mild because they’re natural. Many think that something natural couldn’t hurt them. Yet, serious side effects and drug interactions can occur when taking dietary supplements. For example, supplements such as aloe vera, fenugreek, and vanadium may cause excessive bleeding during surgery or interact with anesthetics. Other supplements may interfere with prescription medications. For instance, ginseng may be used to treat diabetes, but may interfere with the drug warfarin’s ability to prevent blood clotting. St. John’s wort, which people often take for depression, can interact with antidepressants, as well as many other prescription medications. In Part II, you’ll find more examples of side effects and drug interactions for individual supplements.

      Your health care provider is the best resource for assessing the risks and benefits of taking a dietary supplement. He or she should know the potential side effects of supplements—and the risk for interactions with your other medications.

      TALKING TO YOUR HEALTH CARE PROVIDER

      Despite the risks, people generally don’t tell their health care providers that they take dietary supplements. A recent analysis found that 69% of patients who use prescription medications and dietary supplements do not talk about supplements with their health care providers. Certain ethnic groups, such as Hispanics, are less likely than others to tell their health care providers that they take supplements.

      Patients may not consider these products “drugs,” or they may just forget to mention them during their doctor’s visits. Patients may also think their health care providers will disapprove of their choices. Not disclosing supplement use can present dangerous circumstances. For example, a patient may experience a side effect of a dietary supplement that the provider may then attribute to another medication.

      Your pharmacist, doctor, or diabetes educator is the most reliable source for information about the safety and efficacy of dietary supplements. Pharmacists are the most accessible of all health care providers. While retailers in health food stores may seem knowledgeable, they probably don’t have the medical background or familiarity with your personal health to recommend products. The same is true for retailers on the Internet.

      Following are some tips for talking with your doctor, pharmacist or diabetes educator:·

      • Always tell your doctor about any supplements you’re taking, including multivitamins. List them as medications in your written records.

      • Tell your doctor why you are taking that supplement.

      • Don’t wait for your doctor to ask you about your supplement use. Many health care providers forget to ask about these products.

      • Conversely, tell your doctor if you intend to stop or have already stopped taking a supplement.

      • If you’re planning to take a new supplement, ask whether it has any side effects or interactions with other medications or supplements, or whether it may interact with another one of your medical conditions.

      • Ask how the supplement might affect your health—including your blood glucose, blood pressure, cholesterol, or other medical conditions.

      • Your doctor might recommend that you take one product at a time to evaluate how your body reacts. He or she may recommend that you monitor your blood glucose more closely when you start taking a new supplement.

      • Make a list of the supplements you take before your appointment, or put the bottles in a bag and bring them with you. Also list in what dose, how often, and for how long you’ve been taking the supplement.

      • Never stop taking your traditional diabetes medications without telling your health care provider.

      • Continue to be forthright about the supplements you’re taking, even if your doctor has discouraged their use.

      WHERE TO RESEARCH YOUR DIETARY SUPPLEMENTS ONLINE

      If your doctor is unsure about possible side effects or drug interactions, you may want to research information to share with your doctor. The following websites are good places to start:

       http://www.nlm.nih.gov/medlineplus/dietarysupplements.html#cat42

      U.S. National Library of Medicine and National Institutes of Health, “Medline Plus: Dietary Supplements”

       http://ods.od.nih.gov/factsheets/DietarySupplements.asp

      National Institutes of Health Office of Dietary Supplements, “Dietary Supplements: Background Information”

       http://nccam. nih. gov/ health/bottle

      National Institutes of Health National Center for Complementary and Alternative Medicine, “Get the Facts: What’s in the Bottle? An Introduction to Dietary Supplements”

       http://dietarysupplements.nlm.nih.gov/dietary

      National Institutes of Health and U.S. National Library of Medicine Dietary Supplements Labels Database

      REGULATION OF DIETARY SUPPLEMENTS

      If you believe the U.S. Food and Drug Administration (FDA) approves dietary supplements, you are not alone. A 2002 poll showed that 58 percent of Americans believe that government agencies, such as the FDA, must approve herbal products before they can be sold to the public.

      However, dietary supplements do not need FDA approval. Under legislation passed in 1994, called the Dietary Supplement Health and Education Act, supplements are considered foods, not drugs. Therefore, supplements do not have to undergo the same stringent approval process as drugs. Supplement manufacturers do not have to prove the safety, quality,